Most Relevant Information
Provider Data
| NPI Number: | 1003406554 |
| Provider Name: | TRACI KELLY M.ED, BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | 1-21-47100 |
Most Important Dates
| Enumeration Date: | 01/19/2021 |
| Last Updated: | 01/19/2021 |
Provider Practice Location
9636 LEA SHORE ST
FORT WORTH
TX
761793225
Practice Location Phone/Fax
| Phone: | 8176820163 |
| Fax: |
Provider Mailing Location
9636 LEA SHORE ST
FORT WORTH
TX
761793225
Provider Mailing Phone/Fax
| Phone: | 8176820163 |
| Fax: |